Understanding brain lesions

How do you know if brain lesions are related to MS?  A brain MRI showed 3 in my white matter after I went to ER for extreme imbalance dizziness and stumbling.  How often should follow-up MRIs be done?  I also have a diagnosed B12 deficiency, but after 3 months of B12 supplementation, dizziness remains, although other symptoms have become milder.

[Octarine]

JP, I posted a long comment on your journal entry about your questions re B12 deficiency.  Here, I'll comment on your MRI questions.

Everything I know about reading an MRI comes from Quixotic's posts here and the following website:  http://www.radiologyassistant.nl/en/4556dea65db62.  This is from Dutch radiologists who posted a lesson in using MRI images as part of MS diagnosis.  It includes info about various MS mimics and how to tell the difference!

I don't know how (if even possible) to tell MS lesions from vitamin B12 deficiency lesions.  But 3 lesions in the brain, from one MRI, would not be enough.  My understanding from the above sources is that MS lesions typically are:

1.  touching the cortex (juxtacortical) OR
2.  in the corpus collosum OR
3.  in the brain stem OR
4.  in the spine OR
5.  touching the ventricles (juxtaventricular) AND
6.  perpendicular to them (Dawson fingers)

Lesions from other causes do not occur in these locations or are rare there, or do not occur in the "Dawson finger" shape.

Please see the Radiology Assistant web site listed above for a tutorial!

In your journal, you mentioned compromising with your neurologist so that if your B12 supplementation doesn't continue to improve your health, you'll get a followup MRI in a few months.  Not being a doctor, but knowing that people often slip through the cracks, I would urge you to follow up with an MRI anyway.  If it is MS, lesions can be silent, and if new ones do appear, it might be enough to get you a Dx and onto disease-modifying drugs.  But if new ones don't appear, won't you feel relieved?!

Hope this helps you.  Other members, please comment and/or correct me!

[sllowe]

JP - Welcome!

Octarine!!!!!! NICE Job!

JP, welcome to the MS forum.  Octarine has done a fabulous job w/this interp.  

I'll only add a big hello and some advice.  Yup, brain lesions relate to MS as do spinal lesions. Have you had a spinal MRI? MS does generally follow patterns, as mentioned above and I recommend reading Quix's Health Pages too - they are very detailed and describe the lesions best. It's imaging like you received along with "clinical" findings that will steer the Dr toward or away from MS.  There are many mimics that will need ruling out.  

Do you know the extent of your workup so far? If not, I'd inquire with the Dr. Can you get ahold of what they ran in the hospital? It's important to have all of your paperwork in hand.

I've not read your journal yet.  So, I'm sorry if you've already mentioned there.  

Thanks for coming along, and hope to see you around,
-Shelly

[jp518]

I've had MRIs on my cervical and lumbar spine, but not thoracic.  My understanding is that any MS lesions would show up in the thoracic spine area.  I have multiple findings of degenerative disc disease in the cervical spine ranging from mild to severe stenosis, and a vicious bulge at L5-S1, but the surrounding tissue is clear in  both cases.

Yes - I do obtain copies of all my lab reports and imaging studies.  I learned that the hard way with the brain MRI.  I was told about the cyst by my doctor, but she let me wait 2 months for the neurologist to tell me the rest.  I wasn't well prepared for the visit as a result. I do understand that she might have wanted to spare me some anxiety over the CCM and lesions until the expert explained them, but instead I focused on the cyst, which is very benign. I am getting better at asking questions, too.

Thank you for the input.  It's confusing sorting things out.  I worry about being a hypochondriac.  But, since I didn't know about any of these things until I was told I had them, I guess that lets me off that hook.  I can see where I might focus on this stuff too much, though, and I know that can be detrimental.  Just trying to work through this all.

Thanks for helping me think it through.
Judy

[jp518]

Thank you for the information about the lesions above.  I have been trying to find exactly that kind of info. for awhile now. It is a relief.

I'll think about the second MRI.  He seems more focused on the cyst, but insists they rarely grow.  I'm more concerned about the CCM and the lesions.  When I asked about the lesions, he told me they had to do with artheroschlerosis or high bp. I'm not convinced about that since my bp wasn't high until last April. I need to ask my pcp more about my heart test results, too.  Again, the homeocystene level test is a good idea.

Judy

[essdipity]

Octarine has described the 'typical sites' for MS lesions, but just to muddy the waters, not all MS lesions are typical. Not by a long shot. And the MRI is only one tool in the diagnostic process, not the whole shebang. Yours was abnormal (brain), in that there are lesions present, so finding out what they mean should be your neuro's big priority for you.

You also mention MRIs of your spine. MS lesions can appear anywhere in your cervical or thoracic spine, so MRIs are needed for these areas. In fact, spinal lesions are more indicative in diagnosing MS than brain lesions are, because few disorders other than MS cause spinal lesions, whereas brain lesions have numerous potential causes.

If you were normal for all the usual mimics of MS, and if your neuro's physical exam was normal, this makes the B12 issue more likely. Have you had an LP?

Keep tracking everything down and let us know how things are progressing. Meanwhile, our Health Pages are full of vital and correct information.

ess

[doni54]

Hi Judy,

Welcome to the forum, you've come to the right place for support and info.  We all try to help as much as possible.

Everyone has answered your questions, I just wanted to say "hi" and welcome to the forum.

Look forward to getting to know you.

Take care,
doni

[terrics]

'Radiology Assistant web site'    Where is it?  I don't see anything above.  Maybe I'm overlooking it?  Thanks

terrics

[Heather3418]

I think this is the web site everyone was talking about.  Hope MedHelp doesn't **** star out the address, as they sometimes do.

http://www.radiologyassistant.nl/en/4556dea65db62

Heather

[Lulu54]

If the censor  *** out the website again, go to our health page about resources on the WWW and it is listed there.

Welcome to the forum - I believe you will find this all very useful.

My best,
Lulu

[jp518]

Doni,
Thanks for the welcome.  I did two things today that I'm proud of: got a professional massage, and asked and got a referral to a spine specialist from my pcp.  I'm going back to work on Monday (teacher on break) so I'll be spending the rest of my weekend grading papers.
Judy

[jp518]

What's an LP?

As far as possible MS symptoms go - I had (still have to a lesser degree):  face numbness and tingling, muscle cramps (legs, arms, neck), stumbling, intention tremors in my hands, numbness and tingling in my arms and legs, vocab recall difficulties, extreme fatigue, dropping things, periodic lack of arm and hand strength, and the ever present dizziness. I also have almost constant headaches and sporadic head pains. I had one plantar test when my left foot didn't respond up or down. (Right foot responded normally with toes going down.)  I did pass the other neurology office tests as far as I know.

But, as you say, these can all be caused by the B12 deficiency and most can be caused by spine issues.  Because I have central canal and side (foraminal) narrowing due to disc degeneration and bone spurs of my spine on multiple levels, I think I have multiple nerves being pinched. I think it's also telling that I had some temporary relief with PT and the epidural steroid injections. (And possibly telling that the massage I had today caused a killer headache at the base of my skull for awhile - I'm okay now.)

I truly think what's going on is a combination of the b12 deficiency and my spine issues.  The MRI report on my cervical spine made note of a "heterogeneous marrow signal, probably in the normal range".  It was not in the findings, however, and my pcp said it was nothing to worry about.  I do know that B12 deficiency can cause degeneration in the spinal cord itself, however, and am wondering if that's what the marrow signal note could be referring to. Although "marrow" refers to what's in bones . . . Anyway, I'm hoping the spine doctor can explain it better. He or she might also want to look at the thoracic spine given that my pain radiates all through that area. We have an excellent Spine Institute nearby, so I'm hopeful that I'll get some answers.

Thank you for listening and brainstorming with me.  It is such a relief just to have knowledgeable people to talk this over with. And, it inspired me to make the call to again request (she refused the first time) the referral to the spine clinic. I'll wait for the nurse to call with my b12 test results next week, and ask about the MMA and HC tests then.  BTW - I've been so stuck on me that I haven't wished anyone a Happy New Year. So Happy  New Year!
Judy